MEDICARE: KRYKEN INTERNATIONAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	3000361	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3000361	OTHER	IL	HOME SERVICES AGENCY LICENSE

General Provider Information

NPI Number	:	1558814301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRYKEN INTERNATIONAL INC

Provider Business Mailing Address
First Line	:	475 W 55TH ST
Second Line	:	SUITE 105
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-3564
Country	:	US
Telephone Number	:	708-482-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 W 55TH ST
Second Line	:	SUITE 105
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-3564
Country	:	US
Telephone Number	:	708-482-8660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PATRICIA KENNEDY
Credential	:
Telephone Number	:	708-482-8660

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	07/28/2016

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Directions to “KRYKEN INTERNATIONAL INC ” Practice Location

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